Are you able to perform the essential job functions associated with the job for which you have applied without accommodation for a protected disability or religious practice?

Note: Timeliness and good attendance are essential functions for all jobs.*

Yes

No

Is there an accommodation that would permit you to perform the function? *

Yes

No

Please state what the accommodation may be *

Are you legally authorized to work in the U.S for any employer?

Note: Proof of identity and eligibility will be required upon employment*

Yes

No

Are you currently employed? *

Yes

No

May we contact you current employer? *

Yes

No

Have you previously applied at HealthCall? *

Yes

No

Please provide date: *

Have you ever worked at HealthCall? *

Yes

No

Please provide date: *

What was your reason for leaving? *

Do you have any relatives employed at HealthCall? *

Yes

No

If yes, please state their name and relationship. *

How did you hear about this employment opportunity? *

Employee

HealthCall Website

HealthCall Open House

Exterior Signage

Classified Ad

College/University Ad

Mailing/Postcard

Job Fair

Social Media

ZipRecruiter

Indeed

OtherOther

Employee First Name *

Employee Last Name *

If you found HealthCall on social media, please specify which platform (i.e. Facebook, Twitter, etc.). *

If you found HealthCall via a college/university ad or job fair, please specify. *

Are you currently under a legal agreement such as a non-compete agreement or a settlement agreement, which might prevent you from working at HealthCall or from rendering services to specific HealthCall clients? *